POS0471 SPECIFIC SYMPTOM CLUSTERS AT DIAGNOSIS SIGNAL A POORER EARLY RA PROGNOSIS: DATA FROM THE CANADIAN EARLY ARTHRITIS COHORT
Authors: S. J. Bartlett, C. O. Bingham, O. Schieir, M. F. Valois, G. Boire, J. Pope, L. Bessette, C. Thorne, D. Tin, C. Hitchon, G. Hazlewood, E. Keystone, V. Bykerk
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Early RA is characterized by multiple symptoms that impact daily function and HRQL. Little is known about whether there are symptom clusters evident at diagnosis that could identify patients with a poorer prognosis, or the stability of clusters over time. <h3>Objectives</h3> To identify patient-reported symptom clusters at RA diagnosis, associated sociodemographic and RA characteristics, and the stability of clusters over the first 6 months. <h3>Methods</h3> Using data from the Canadian Early Arthritis Cohort (CATCH), we applied <b>latent class analysis</b> with baseline PROMIS-29 pain, fatigue, depression, anxiety, and sleep scores to select relevant symptoms and levels using AIC, BIC, G-square and log-likelihood results. Baseline PRO and clinical differences among clusters were compared. Next, we evaluated the stability of these clusters at 3 and 6 months. <b>Latent transition analysis</b> was used to estimate the probability of transitioning among classes. <h3>Results</h3> The sample included 310 adults with a new RA diagnosis, with 6-month PROs available, and who were MTX naïve at baseline. Participants had a mean age 56, CDAI 29.3, and symptoms for 5 months; 67% were women and 78% White. The optimal symptom set included pain, fatigue, depression, and anxiety (levels: none, mild, moderate, severe). We identified 4 clusters: <b>Minimal</b> (12%); <b>Moderate Pain Dominant</b> (40%); <b>Multiple Moderate-Severe</b> (35%); and <b>Multiple Mild</b> (11%). Clusters had similar sociodemographics except <b>Minimal</b> were slightly older and less female; SJC and TJC were similar among classes <b>Multiple Mild</b> or <b>Moderate-Severe</b> classes had significantly worse mood and sleep (Table 1). More patients in <b>Multiple Moderate-Severe</b> and <b>Moderate Pain</b> had parenteral steroids whereas numerically more in <b>Minimal</b> or <b>Multiple Mild</b> groups were on oral steroids. RA Participant Characteristics around diagnosis by symptom clusters. Substantial improvement was evident in 67% at 3 months (42% <b>Minimal,</b> 25% <b>Multiple Mild;</b> Figure 1). At 6 months, 45% were <b>Minimal</b> and 25% <b>Multiple Mild</b>. The best prognosis was for <b>Minimal</b>; almost all stayed <b>Minimal</b> at 3 (95%) and 6 (87%) months. Next best was <b>Moderate Pain</b> where 71% improved (<b>Minimal</b> 64%; <b>Multiple Mild</b> 7%). A poorer prognosis was seen for <b>Multiple Moderate-Severe</b>: at 3 months, 61% improved (13% <b>Minimal</b>, 33% <b>Multiple Mild</b>). <b>Multiple Mild</b> also were less likely to improve with 11% <b>Minimal</b> and 6% worsening by 3 months. <h3>Conclusion</h3> In this large early RA cohort, we identified 4 distinct symptom clusters around diagnosis that were stable over 6 months and had distinct PRO profiles. At baseline, most (70%) participants were classified as <b>Moderate Pain</b><b>Dominant</b> or <b>Multiple Moderate Symptoms</b>; the remainder had <b>minimal</b><b>or</b><b>multiple mild symptoms</b>. By examining symptom clusters, we found more homogeneous groups of patients. Our results also suggested that having multiple symptoms around diagnosis was associated with less improvement over the first 6 months, and may signal a more guarded prognosis for symptom improvement and HRQL in early RA. <h3>Acknowledgements</h3> CATCH was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada since 2007; AbbVie Canada since 2011; Medexus since 2013; Sandoz Canada since 2019; Fresenius Kabi Canada since 2021; Organon Canada since 2021. Previous funding from Hoffman La Roche (2011-21); Sanofi Genzyme (2016-7); Eli Lilly Canada (2016-20); Merck Canada (2017-21) and; Gilead Sciences Canada (2020-21). <h3>Disclosure of Interests</h3> Susan J. Bartlett Speakers bureau: Amgen, Janssen, Organon, Merck, Pfizer, Sandoz, Consultant of: Janssen, Merck, Organon, Sandoz, Clifton O Bingham: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Gilles Boire Speakers bureau: Merck, BMS, Pfizer, Janssen, Consultant of: Amgen, BMS, Celgene, Eli Lilly, Pfizer, Grant/research support from: Amgen, Abbvie, BMS, Eli Lilly, Merck, Novartis, Pfizer, Sandoz, Janet Pope Speakers bureau: UCB, Sandoz, Consultant of: AbbVie, Actelion, Amgen, Bayer, BMS, Eicos Sciences, Eli Lilly &amp; Company, Emerald, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Grant/research support from: Abbvie, BMS, Eli Lilly &amp; Company, Merck, Roche, Seattle Genetics, UCB, Louis Bessette Speakers bureau: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Consultant of: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Grant/research support from: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Carter Thorne Consultant of: Abbvie, Amgen, Celgene, Centocor, Janssen, Lilly, Medexus/Medac, Merck, Novartis, Pfizer, Sanofi, Grant/research support from: Abbvie, Celgene, CaREBiodam, Novartis, Pfizer, Diane Tin: None declared, Carol Hitchon Grant/research support from: Pfizer and UCB, Glen Hazlewood: None declared, Edward Keystone Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Bristol-Myers Squibb Company, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis, Grant/research support from: AbbVie, Amgen, Gilead Sciences, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, PuraPharm, Sanofi, Vivian Bykerk Consultant of: Amgen, BMS, Gilead, Regeneron, UCB, Grant/research support from: Amgen, BMS, Genzyme, Pfizer, Regeneron Sanofi Aventis, UCB.